|
HC ASSAY OF CALPROTECTIN FECAL
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
3018399301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.60 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$206.08
|
| Rate for Payer: Altius Commercial |
$309.12
|
| Rate for Payer: Beech Street Commercial |
$315.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$312.34
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: Entrust Commercial |
$305.90
|
| Rate for Payer: First Choice Health Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.42
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$186.60
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$315.56
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$196.42
|
| Rate for Payer: United Healthcare Commercial |
$307.51
|
| Rate for Payer: United Healthcare Medicare |
$196.42
|
| Rate for Payer: WINHealth Partners Commercial |
$305.90
|
| Rate for Payer: Wise Provider Network Commercial |
$305.90
|
|
|
HC ASSAY OF CALPROTECTIN FECAL
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
3018399301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$174.36 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$212.52
|
| Rate for Payer: Altius Commercial |
$309.12
|
| Rate for Payer: Beech Street Commercial |
$315.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$312.34
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: Entrust Commercial |
$305.90
|
| Rate for Payer: First Choice Health Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$183.54
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$174.36
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$315.56
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$183.54
|
| Rate for Payer: United Healthcare Commercial |
$307.51
|
| Rate for Payer: United Healthcare Medicare |
$183.54
|
| Rate for Payer: WINHealth Partners Commercial |
$315.56
|
| Rate for Payer: Wise Provider Network Commercial |
$305.90
|
|
|
HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
3018015601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.88 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.30
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$102.88
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$108.30
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare |
$108.30
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
3018015601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$121.60
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.90
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$110.10
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.90
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare |
$115.90
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC ASSAY OF CARNITINE - CARNITINE
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
3018237901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.26 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$206.78
|
| Rate for Payer: Aetna of WY Medicare |
$139.26
|
| Rate for Payer: Altius Commercial |
$202.56
|
| Rate for Payer: Beech Street Commercial |
$206.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.67
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$204.67
|
| Rate for Payer: Cigna of WY Commercial |
$206.78
|
| Rate for Payer: Entrust Commercial |
$200.45
|
| Rate for Payer: First Choice Health Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.27
|
| Rate for Payer: HealthUtah PPO |
$211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$204.67
|
| Rate for Payer: Multiplan Medicare/VA |
$114.26
|
| Rate for Payer: One Health Plan of WY PPO |
$206.78
|
| Rate for Payer: PacificSource Commercial |
$189.90
|
| Rate for Payer: PHCS PPO |
$206.78
|
| Rate for Payer: Three Rivers PPO |
$158.25
|
| Rate for Payer: TriWest Veterans Administration |
$120.27
|
| Rate for Payer: United Healthcare Commercial |
$201.50
|
| Rate for Payer: United Healthcare Medicare |
$120.27
|
| Rate for Payer: WINHealth Partners Commercial |
$206.78
|
| Rate for Payer: Wise Provider Network Commercial |
$200.45
|
|
|
HC ASSAY OF CARNITINE - CARNITINE
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
3018237901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$206.78
|
| Rate for Payer: Aetna of WY Medicare |
$135.04
|
| Rate for Payer: Altius Commercial |
$202.56
|
| Rate for Payer: Beech Street Commercial |
$206.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.67
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$204.67
|
| Rate for Payer: Cigna of WY Commercial |
$206.78
|
| Rate for Payer: Entrust Commercial |
$200.45
|
| Rate for Payer: First Choice Health Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.71
|
| Rate for Payer: HealthUtah PPO |
$211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$204.67
|
| Rate for Payer: Multiplan Medicare/VA |
$122.27
|
| Rate for Payer: One Health Plan of WY PPO |
$206.78
|
| Rate for Payer: PacificSource Commercial |
$189.90
|
| Rate for Payer: PHCS PPO |
$206.78
|
| Rate for Payer: Three Rivers PPO |
$158.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.71
|
| Rate for Payer: United Healthcare Commercial |
$201.50
|
| Rate for Payer: United Healthcare Medicare |
$128.71
|
| Rate for Payer: WINHealth Partners Commercial |
$200.45
|
| Rate for Payer: Wise Provider Network Commercial |
$200.45
|
|
|
HC ASSAY OF CAROTENE - CAROTENE, SERUM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 82380
|
| Hospital Charge Code |
3018238001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.26
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.38
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$33.61
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.38
|
| Rate for Payer: United Healthcare Commercial |
$55.39
|
| Rate for Payer: United Healthcare Medicare |
$35.38
|
| Rate for Payer: WINHealth Partners Commercial |
$55.10
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC ASSAY OF CAROTENE - CAROTENE, SERUM
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 82380
|
| Hospital Charge Code |
3018238001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$38.28
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.26
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.06
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$31.41
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.06
|
| Rate for Payer: United Healthcare Commercial |
$55.39
|
| Rate for Payer: United Healthcare Medicare |
$33.06
|
| Rate for Payer: WINHealth Partners Commercial |
$56.84
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 82390
|
| Hospital Charge Code |
3018239001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$90.42
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.89
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.09
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$74.19
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.09
|
| Rate for Payer: United Healthcare Commercial |
$130.84
|
| Rate for Payer: United Healthcare Medicare |
$78.09
|
| Rate for Payer: WINHealth Partners Commercial |
$134.26
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 82390
|
| Hospital Charge Code |
3018239001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$87.68
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.89
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.57
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$79.39
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$83.57
|
| Rate for Payer: United Healthcare Commercial |
$130.84
|
| Rate for Payer: United Healthcare Medicare |
$83.57
|
| Rate for Payer: WINHealth Partners Commercial |
$130.15
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC ASSAY OF CHROMIUM - CHROMIUM LEVEL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 82495
|
| Hospital Charge Code |
3018249501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$81.92
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.08
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$74.18
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.08
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$78.08
|
| Rate for Payer: WINHealth Partners Commercial |
$121.60
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ASSAY OF CHROMIUM - CHROMIUM LEVEL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 82495
|
| Hospital Charge Code |
3018249501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$84.48
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.96
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$69.31
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$72.96
|
| Rate for Payer: WINHealth Partners Commercial |
$125.44
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ASSAY OF CITRATE - CITRATE 24 HOUR URINE
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
3018250701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$180.18
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.61
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$147.83
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$155.61
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$155.61
|
| Rate for Payer: WINHealth Partners Commercial |
$267.54
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY OF CITRATE - CITRATE 24 HOUR URINE
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
3018250701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$174.72
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.53
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$158.20
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.53
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$166.53
|
| Rate for Payer: WINHealth Partners Commercial |
$259.35
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY OF CITRATE - CITRATE RANDOM URINE
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
3018250703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$180.18
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.61
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$147.83
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$155.61
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$155.61
|
| Rate for Payer: WINHealth Partners Commercial |
$267.54
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY OF CITRATE - CITRATE RANDOM URINE
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
3018250703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$174.72
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.53
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$158.20
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.53
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$166.53
|
| Rate for Payer: WINHealth Partners Commercial |
$259.35
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.05 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$128.04
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.18
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.58
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$105.05
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.58
|
| Rate for Payer: United Healthcare Commercial |
$185.27
|
| Rate for Payer: United Healthcare Medicare |
$110.58
|
| Rate for Payer: WINHealth Partners Commercial |
$190.12
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.42 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$124.16
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.18
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.34
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$112.42
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$118.34
|
| Rate for Payer: United Healthcare Commercial |
$185.27
|
| Rate for Payer: United Healthcare Medicare |
$118.34
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC ASSAY OF CK (CPK) ISOENZYMES
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.71
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$55.77
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$58.71
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$58.71
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC ASSAY OF CK (CPK) ISOENZYMES
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$65.92
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.83
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$59.69
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.83
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$62.83
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC ASSAY OF CLOZAPINE - CLOZAPINE
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$114.84
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.18
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$94.22
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.18
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$99.18
|
| Rate for Payer: WINHealth Partners Commercial |
$170.52
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC ASSAY OF CLOZAPINE - CLOZAPINE
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$111.36
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.14
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$106.14
|
| Rate for Payer: WINHealth Partners Commercial |
$165.30
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC ASSAY OF COPPER - COPPER 24HR URINE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.95
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$73.10
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$76.95
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$76.95
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC ASSAY OF COPPER - COPPER 24HR URINE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$86.40
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.35
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$78.23
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC ASSAY OF COPPER - COPPER RANDOM URINE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$86.40
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.35
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$78.23
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
